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General NPI Number Information
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NPI Number | 1184936262
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Entity Type | Individual
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Provider Name | KIMBERLY SUE GUTIERREZ RPH., N.D
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Gender | Female
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 505 NW 9TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3578
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Country | US
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Telephone | 503-422-6913
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Fax | 888-511-7659
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Provider Business Mailing Address
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Address Line | 505 NW 9TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-3578
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Country | US
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Telephone | 503-422-6913
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Fax | 888-511-7659
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0010622
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH0010622
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 3003
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License Number State | OR
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